Canakinumab (Ilaris)

Ilaris (canakinumab) is covered only for FDA‑approved indications—CAPS (FCAS, MWS) in patients ≥4 years, TRAPS, HIDS/MKD, FMF (adult and pediatric), and active sJIA in patients ≥2 years—and off‑label uses are excluded. Coverage requires prescribing by or consultation with specified specialists, adherence to age- and weight‑based dosing limits, sJIA prior‑therapy criteria (trial of ≥2 other biologics or specified poor‑prognosis/MAS pathways with trials of Actemra/Kineret), documentation of diagnosis/age/prior therapies and clinical response for reauthorization, and initial approvals of 3–4 months with 12‑month renewals.

"Ilaris is indicated for the treatment of Cryopyrin-Associated Periodic Syndromes (CAPS), in adults and children 4 years of age and older including: Familial Cold-Autoinflammatory Syndrome (FCAS); M..."

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